From selection to outcome
Erle, J.B., Goldberg, D.A. (2003). The course of 253 analyses from selection to outcome. Journal of the American Psychoanalytic Association, 51, 257-292.
This paper presents two studies of the clinical work of experienced psychoanalysts, all of them trained at, and members of, the New York Psychoanalytic Institute. Study I is a retrospective study of all of the analytic work of sixteen analysts from 1973 to 1977 (161 patients), including their evaluations of the treatments. Study II is a prospective study of all the patients started in analysis by a group of twenty analysts between l984 and l989 (ninety-two patients) and followed to termination, again including evaluative reports. The participating analysts were not chosen as a representative group; we invited those we thought shared our interest in such a study. Similarly, the patients were not intended to be representative: they were the patients these analysts saw in analysis during the study periods, except those omitted for reasons of confidentiality. The analysts shared the view that analysis had been a beneficial treatment for many patients; each had had experience with patients where an analytic process did not develop.
In both studies, participating analysts reported their assessment of their patients' analyzability at the initial evaluation. These assessments were reviewed, and sometimes revised, in the subsequent periodic reports and at termination. Where an analytic process did not develop, the rating “unanalyzable” was used; in those cases, treatment was interrupted or continued as psychotherapy. We did not attempt to investigate the question of whether work with another analyst might have had a different outcome, either with patients where an analytic process did develop or where it did not. There were reports of patients with histories of apparently unsuccessful analytic treatment who were thought to be analyzable in this treatment.
The rating used here reports only the analyst's view of the outcome of this treatment; that is, the patient is designated analyzable or unanalyzable by this analyst in this treatment at this time. There are a number of factors that could produce different outcomes, such as the influence of a different theoretical position on technique or the impact of a different analyst. Kantrowitz (l995) has drawn attention to the issue of “match,” which she suggests may be crucial to the success or failure of some analytic treatments.
Joan B. Erle, is Training and Supervising Analyst, New York Psychoanalytic Institute.
Daniel A. Goldberg is on the faculty of the New York Psychoanalytic Institute.
The authors want to express their gratitude for the generous and thoughtful participation of the twenty-four analysts who made this study possible.